{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:47:59Z","timestamp":1792068479116,"version":"4.4.0"},"reference-count":41,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":287,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["32271095"],"award-info":[{"award-number":["32271095"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Depression and Anxiety"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    Obsessive\u2013compulsive disorder (OCD) is a chronic and disabling condition, and although exposure and response prevention (ERP) is the first\u2010line psychological treatment, many patients decline it, drop out, or retain residual symptoms. According to Wells\u2019 metacognitive model, OCD is maintained less by intrusive thoughts themselves than by metacognitive beliefs about the significance, danger, and control of thoughts, which metacognitive therapy (MCT) targets directly. However, individual MCT has been evaluated almost exclusively in high\u2010income Western settings, and whether metacognitive belief change temporally precedes symptom improvement remains untested. This multisite, assessor\u2010blinded randomized controlled trial (RCT) addressed both gaps in Pakistani outpatient services. Seventy\u2010six adults with OCD were randomized to 12 weekly sessions of individual MCT (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200938) or documented treatment as usual (TAU;\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200938) and assessed at baseline, post\u2010treatment, and 6\u2010month follow\u2010up; outcomes were analyzed with intention\u2010to\u2010treat (ITT) mixed\u2010effects models and an exploratory three\u2010wave panel mediation model. MCT produced greater reductions in clinician\u2010rated Yale\u2010Brown Obsessive\u2010Compulsive Scale severity than TAU,\n                    <jats:italic>F<\/jats:italic>\n                    (1.81, 134)\u2009=\u200911.30,\n                    <jats:italic>p<\/jats:italic>\n                    &lt; 0.001, with mean differences of \u22124.00 at post\u2010treatment and \u22126.92 at follow\u2010up (both\n                    <jats:italic>p<\/jats:italic>\n                    &lt; 0.001) and more frequent treatment response. MCT also reduced Metacognitions Questionnaire\u201030 belief domains, with gains maintained at follow\u2010up. However, the prespecified lagged indirect effect through post\u2010treatment beliefs was not supported (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009=\u2009\u22120.01). Findings extend the evidence for MCT to a non\u2010Western clinical context and suggest that broad metacognitive belief domains behave as markers of clinical state rather than proximal mechanisms, underscoring the need for temporally fine\u2010grained mechanism research.\n                  <\/jats:p>","DOI":"10.1155\/da\/5060244","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T11:54:58Z","timestamp":1792065298000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing the Impact of Metacognitive Therapy on OCD Severity and Beliefs: A Three\u2010Wave Multisite RCT With Panel Mediation Analysis"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7026-2130","authenticated-orcid":false,"given":"Saeed","family":"Anwar","sequence":"first","affiliation":[{"name":"School of Psychology Northeast Normal University  Changchun 130024 China  nenu.edu.cn"},{"name":"Jilin Provincial Higher Education Key Laboratory of Cognitive and Brain Science  Changchun China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7541-0912","authenticated-orcid":false,"given":"Romana","family":"Younas","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Cognitive Science and Mental Health Institute of Psychology Chinese Academy of Sciences  Beijing 100101 China  cas.cn"},{"name":"Department of Psychology University of Chinese Academy of Sciences  Beijing China  ucas.ac.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wejdan","family":"Deebani","sequence":"additional","affiliation":[{"name":"Department of Mathematics Faculty of Science and Arts King Abdul Aziz University  Rabigh Saudi Arabia  kau.edu.sa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9965-5474","authenticated-orcid":false,"given":"Jiang","family":"Yingjie","sequence":"additional","affiliation":[{"name":"School of Psychology Northeast Normal University  Changchun 130024 China  nenu.edu.cn"},{"name":"Jilin Provincial Higher Education Key Laboratory of Cognitive and Brain Science  Changchun China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"e_1_2_14_1_2","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","author":"American Psychiatric 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